May 2014

2019 OPEN ENROLLMENT ENDS (most states)

OK, contributor deaconblues sent me a link yesterday which gave updates as of 5/27...but when I checked the link this morning, it was dated 5/28 and the numbers were all slightly higher!

If I'm reading this correctly, Minnesota seems to have decided to start posting daily updates now, which is ironic given that HHS has stopped issuing updates completely!

Frankly, for my purposes, the only way that this could be any handier would be if they included a hard "paid" count with each update, but they've repeatedly made it clear that they average around 95% so that's not a problem:

Regular readers of this site know that the ACA Signups project started over at Daily Kos. This is the first time I can recall using dKos as a primary source for a story link. I'm sorry to say it's not exactly a flattering one as far as Maryland's ill-fated state exchange is concerned:

Maryland's health exchange website, which is best known for falling to pieces on Oct. 1, will be scrapped after $129 million in spending. In April, the Maryland Health Exchange board voted to adopt Connecticut's web application.

At the time officials refused to say they were junking the Noridian-designed system. It was a just revamping ... right.

However, the state can't transfer data from one system to the other.

The fix? Contact 275,000 Medicaid enrollees -- about 75% of the people on the exchange -- and have them log onto a new system and put their information in again.

A rather depressing end to Nevada's first open enrollment period. The state pushed their extension period far beyond any other state (most states stopped at 4/15; Oregon's was 4/30...Nevada kicked it out another month beyond that to 5/30), and still didn't come close to either their initial target or even my own "fair share" target of 73,000 QHP enrollees:

About 35,700 consumers have purchased insurance coverage through the program. Enrollment is far less than an initial target of 118,000.

(and yes, that 35,700 figure is paid, not total; the total number stood at 47,245 a couple of weeks ago).

Not exactly an earth-shattering update, but Hawaii has, interestingly, managed to increase their SHOP enrollments by over 20% in the past week.

Plus, they, along with Oregon and Minnesota, get kudos from me for continuing regular updates regardless of how minor the changes are. Wish NY, CA and HHS would follow their lead on this topic, at least (obviously not so much the technical side of things...)

Nice catch by contributor Esther F....in this article about new parents having a 60-day "Qualifying Life Event" period to add their newborn child to their healthcare plan, there's this bit at the end:

About 164,000 Washington residents enrolled for private health coverage during the last open-enrollment period. About 2,000 or 3,000 have enrolled since then, Frey said.

Those include special enrollments along with “special special” enrollments — people still completing applications because of technical problems, Frey said.

OK, kind of a fuzzy number, but let's split the difference and call it 2,500. That means Washington State has increased their enrollment by about 1.5% since the end of March (WA was one of 2 states--Connecticut was the other one--which did not offer an official extension period). As the article was originally posted on 5/27, the latest the figures could run through is 5/26, so that's about 45 people per day since 3/31. Assuming this pace holds steady, WA should add over 10,000 QHP enrollees to their total by the time the 2nd enrollment period starts on 11/15.

Greg Sargent and Glenn Kessler (both at the Washington Post) have sort of tag-team pieces this morning about Mitch McConnell's ongoing verbal gymnastics as he continues to try and say "I will repeal Obamacare completely" and "We should keep Kynect intact" simultaneously, even though "Obamacare" and "Kynect" are both "The Patient Protection and Affordable Care Act."

This story out of Connecticut breaks down their Medicaid enrollees using a handy chart and some very specific numbers, giving fairly hard "Strict Expansion" and "Woodworker" updates:

Unsurprisingly, the biggest percentage growth occurred among adults who don’t have minor children. The income limit for people in that category [HUSKY D] to qualify for coverage rose Jan. 1 as part of the federal health law commonly known as Obamacare, from 56 percent of the poverty level to 138 percent.

...But another portion of the Medicaid program also saw a significant enrollment increase, even though eligibility requirements remained largely unchanged. That portion, known as HUSKY A, covers low-income children and their parents.

...Between the end of September and the end of April, total number of people in HUSKY D rose from 94,058 to 137,260 -- a growth of 43,202 people.

During that time, the number covered by HUSKY A grew by 29,792 people, to 460,103 members.

A big shout-out to Nick Budnick of The Oregonian, who has been all over Cover Oregon's horribly-troubled-but-surprisingly-successful healthcare exchange from the get-go. He just released a big new story which features an extensive breakdown of Oregon's overall individual insurance market, including both on-exchange QHPs, off-exchange QHPs, grandfathered noncompliant plans and even the "small group" ESI market, among other things. Thankfully, all of these numbers are broken out so I'm able to make sense of them.

When I last checked in on the state of Arkansas' unusual "private Medicaid option" a month ago (which uses Medicaid money to pay for private exchange QHPs...basically a QHP with a 100% subsidy, but still counted as Medicaid instead), the tally stood at around 155,000.

Today, that number has risen another 15,000 people and now stands at over 170K, or over 75% of the 225,000 estimated Arkansas residents eligible for the program:

According to testimony today from the Arkansas Department of Human Services, 170,033 people through the end of April have been deemed eligible and gained coverage under the private option, the state's unique plan using Medicaid funds to purchase private health insurance for low-income Arkansans. This likely means that the policy has already made a significant reduction in the rate of uninsurance in the state. The private option has also made the Arkansas Health Insurance Marketplace as a whole dramatically younger, which could help lead to lower premiums in the future. Details below the jump.

OK, so that's another 166 QHPs and 958 more people added to Medicaid in the past 4 days.

MN's off-season QHP rate is now 697 in 34 days, or 20.5 per day. If that holds steady, that's around 615 per month, or around 4,300 more QHPs by the time the 2nd open enrollment period opens on November 15.

Way back on March 21st (wow, that seems like forever ago, doesn't it?), I posted the following towards the end of "The Paid/Unpaid Brouhaha":

So, I'll say this here and now:

Whatever percentage of total exchange-based QHP enrollments still haven't been paid by the policyholder as of May 31st should indeed be subtracted from the official HHS total number, assuming that those non-payments are due to either a) the policyholder bailing/refusing to pay or b) the government-run exchange (not the insurance company's billing system) screwing up.

If the total number ends up being 6.2 million but the non-payments fitting these criteria are 7% as of May 31st, I'll gladly subtract 434,000 from the total. If the total number is 6.5M and the non-payments are 10% as of 5/15, I'll subtract 650,000, and so on.

Well, it's not quite May 31st, but I wanted to make sure to get this blog entry off my chest before June 1st, so I'm giving the Republican Party a 4-day lead time.

OK, according to the March/April HHS report, Colorado's official QHP tally as of 4/19 was 125,402. However, according to the state exchange itself, the tally as of 4/15 (the actual end of open enrollment) was 127,233. I'm not sure whether the difference is due to purging unpaid enrollments, clerical errors on one side or the other or what, but they appear to have added either another 2,919 QHPs between 4/20 - 5/03, or another 1,088 between 4/16 - 5/03, depending on which starting number/date you use:

I am an insurance agent and in the communities I serve...south texas...San Antonio, Austin, we saw limited demand...so these numbers amaze me...can I advertise on your site...and reference you on my site?

I took a look at your website, and I'm a little confused. According to your site, the healthcare policies you offer are "not Obamacare compliant". There's technically no such thing as "Obamacare"...the actual name of the law is "The Patient Protection and Affordable Care Act", generally shortened as "the Affordable Care Act." While "Obamacare is a popular nickname for the law, it's a bit troubling to see a supposedly professional insurance agency using slang terminology throughout the website.

Now that we're completely out of the Open Enrollment period (for QHPs, anyway), it'll be interesting to see how the QHP numbers climb based purely on Qualifying Life Events and Native American enrollees.

Minnesota's final official number as of 4/22 (they bumped their extension period out an extra week from the normal 4/15) was 50,096, so they've added another 663 people in the first month since then, or around 1.3%.

Assuming that rate ends up being typical of both MN specifically and is representative nationally (and of course there's absolutely no evidence that either of these will be the case), this would mean:

Over the past 7 months, plenty of healthcare reporters, insurance executives and political pundits have started following this site and/or my Twitter feed. For the most part the ones I know of tend to be either of unknown ideology or left-leaning, but there's also a substantial number of Republican, Conservative, Libertarian or other wise right-leaning types, and that's fine.

I've butted heads publicly with a few of these folks. In some cases they've presented honest, intelligent disagreement; in others they've spewed tired, BS talking points. Here's a great opportunity to prove whether you're dealing an intellectually honest hand or not. I present you with the following:

I spent a lot of time the past couple of days hammering on the HHS Dept. for announcing that they're discontinuing their official monthly enrollment reports. However, it also occurs to me that I haven't heard a peep out of most of the state-run exchanges in almost a month either:

That's not me saying it; that's the actual headline and the conclusion of a report by the Robert Wood Johnson Foundation:

RENTON — The first look at the Affordable Care Act’s impact on New Jersey reveals the percentage of uninsured people is on track to reach its lowest level in nearly a quarter of a century, according to a new report released Thursday by the Robert Wood Johnson Foundation.

The proportion of uninsured adults decreased 38 percent from September to early March, according to the foundation. That decline is likely to accelerate, knowing that many people waited until the last minute to beat the March 30 enrollment deadline.

"These findings suggest that uninsurance in New Jersey is at its lowest level since 1990," according to the report produced by the foundation and the Rutgers Center for State Health Policy.

Given the "How many have PAID???" fuss & bother, I've been debating how to handle an interesting number-crunching dilemma ever since the (final???) HHS report for March/part of April was released a few weeks back.

The question is this: When people ask "how many have paid?" their first month's premium, are they really interested in the percentage or in the actual number of people who are paid up?

This may seem like a curious distinction, but consider the following: Officially, the maximum total number which could potentially be "fully enrolled" (ie, premium paid) is 8,019,763. That's the number that the HHS Dept. listed in their last report, which runs through April 19th.

Your office is not supposed to be a political one. I, however, have the luxury of not being restricted by that fact. I'm a proud, unapologetically progressive Democrat. While I certainly have my issues with President Obama and the ACA, in general I think that it's an excellent start towards an eventual goal of a single payer healthcare system. While I'm still disapointed as to why they didn't simply drop the "65" age requirement from Medicare (perhaps phasing it in 5 years at a time...60, 55, 50 and so on, with an accompanying funding mechanism), or at the very least add a Public Option to compete with the private corporations, I do understand that the political realities at the time presumably didn't allow for either one.

I received some disturbing news this morning which, if true, will piss me off to no end.

Supposedly, now that the open enrollment (and extension) period is over, the HHS Dept. has decided NOT to issue any further monthly ACA exchange enrollment reports going forward.

I don't know if this only means that they're mothballing the reports from now through November (when the 2nd open enrollment period starts up again), which would be bad enough, or if they mean permanently (which would be far worse).

I should stress that I have not confirmed this yet; if this information is incorrect, disregard everything below.

Assuming this news is accurate, however, HHS has lost their mind and will deserve every bit of criticism that they receive over it.

I've said many times before that the only reason that I started this website in the first place is because neither the HHS Dept. nor the major news media outlets seemed to be willing (or able?) to post accurate exchange enrollment data on a timely basis (and by "timely", I mean daily or weekly, not monthly, which is just too damned long in the modern political/media world).

First Oregon told Oracle to go pound sand after paying the company hundreds of millions of dollars for a useless website; now Nevada has officially done the same thing to Xerox:

The Silver State Health Insurance Exchange board voted unanimously Tuesday to end its relationship with Xerox, the vendor contracted in 2012 to build the exchange’s Nevada Health Link website.

In place of Xerox, the exchange will adopt the federal Healthcare.gov exchange’s eligibility and enrollment functions for the sign-up period that begins Nov. 15, though it will keep its status and funding as a state-controlled system. The exchange will also issue a request for proposals to evaluate replacement systems in coming years. A new platform could come from a state with a functional marketplace, or from a vendor with a similar, proven program.

Unlike Massachusetts, which is taking a dual-path approach (they're scrambling to replace their own crappy site with a new one while simultaneously preparing to move over to HC.gov just in case the first plan doesn't pan out in time), Nevada is sort of doing the opposite: They're moving over to HC.gov this year, but reserving the right to try a do-over on their own exchange for 2016 and beyond.

Interestingly, even though we're well past even the extended QHP enrollment period, Hawaii continues to have new enrollments trickle in. I'm not sure if these are clerical corrections from before 4/30 or if these are "Qualifying Life Events", but either way they just added another 111 people to the tally (plus a whopping 5 more people in their SHOP enrollments).

Wyoming's QHP enrollments didn't add up to much (understandable given that the entire state only has 576,000 people), but the state insurance commissioner states that around 92% of those who did enroll have paid up so far:

Nearly 12,000 people in Wyoming have enrolled in a plan on the federal marketplace created by the Affordable Care Act, according to the latest data announced Monday at a legislative committee meeting.

About 11,000 of them have begun paying their premiums, Wyoming Insurance Commissioner Tom Hirsig told members of the Joint Labor, Health and Social Services Committee at Casper College.

The actual number of exchange QHPs in Wyoming is 11,970, so yep, 11K would be about 92% of that.

(To clarify the last statement: Contributor Esther F. also gives a link to another story which clarifies that the "7-8K" quote refers to how many people he thought would enroll, not how many he figured would pay):

Michigan continues to quietly enroll thousands and thousands of people in ACA-expanded Medicaid, having already reached 81% of the 320K first-year goal in just 7 weeks (or, alternately, 52% of the total eligible for expanded Medicaid state-wide):

OK, due to my unexpectedly-far-longer-lasting bout of shingles, I've gotten a bit backed up with my ACA news the past few weeks, but I did want to address the "cost per enrollee" story which popped up a week or so ago:

Sometimes there really are economies of scale. And the nation’s health insurance exchanges may be a case in point.

As rocky as its rollout was, it cost the federal exchange, healthcare.gov, an average of $647 of federal tax dollars to sign up each enrollee, according to a new report. It cost an average of $1,503 – well over twice as much – to sign up each person in the 15 exchanges run by individual states and Washington, D.C.

The article (and others like it) goes on to break out the individual state exchange costs. Some do better than others, of course, and Hawaii comes in dead last (in part simply because their uninsured population is so small to begin with). While it's certainly interesting to see which ones were the most efficient and which were the least, there's a big part of me which keeps asking "why is anyone surprised by this?"

In spite of all the hand-wringing that people have had about the insurance company premium rates for the 2nd year of the exchanges (this is the main reason for all the freaking out about how many "young invincibles" there would be, etc etc), the truth is...the new premium levels appear to be all over the place:

May 15--A first-glance snapshot of the lowest premium rates being proposed for individual health-insurance plans to be sold in the Washington Healthplanfinder exchange marketplace reveals spirited competition and more choices for consumers.

These rates are not yet approved, and it's likely the number of plans requested will decline, according to the Office of the Insurance Commissioner.

That office is now reviewing rate changes the companies requested.

Changes proposed by companies asking to sell plans on Healthplanfinder ranged from a nearly 7 percent decrease in one case to an increase of more than 11 percent in others.

If I'm reading this correctly, the breakdown of new Medicaid enrollees in Iowa is 20K "strict expansion" and another 75K who are either renewals or woodworkers. Using my 20% rule of thumb, that should be around 15,000 woodworkers:

Of the 95,000 Iowans enrolled in the state's health insurance programs - collectively called the Iowa Health and Wellness Plan - more than 75,000 are Medicaid carryovers or people newly eligible for Medicaid under the program's expansion. More than 1,900 such people came from Dubuque County.

...The rest of the Iowa Health and Wellness Plan enrollees - almost 20,000 - are enrolled through the state's alternative to further Medicaid expansion. They have incomes between 100 percent and 133 percent of the federal poverty level. Of these, 556 were from Dubuque County.

They may have flushed a couple hundred million dollars down the drain on their website, but that just makes Oregon's manual QHP processing achievement all the more impressive. Over 6 weeks after the official enrollment period ended, and over 2 weeks after their extension period wrapped up, Oregon continues to push their QHP and Medicaid enrollment totals up:

A slight increase in exchange QHPs since mid-April (either via final data entry corrections or qualifying life events?), and a solid increase in Medicaid/CHIP enrollees:

As of April 29, 2014, 275,090 individuals have gained Medicaid coverage in 2014 and remain active in Medicaid. This includes the 95,889 PAC enrollees who were automatically converted on January 1, 2014 to full Medicaid coverage.

As of May 10, 2014, 67,907 individuals have enrolled in a qualified health plan.

The Hospital Corporation of America, which has facilities in 20 states, reported a big gap in Medicaid and uninsured admissions between expansion and non-expansion states. In the four states it operates where Medicaid expanded under the ACA, the company saw a 22.3 percent growth in Medicaid admissions, compared to a 1.3 percent decline in non-expansion states. The company also had a 29 percent decline in uninsured admissions in the expansion states, while non-expansion states experienced 5.9 percent growth in uninsured admissions, chief financial officer William Rutherford said.

I may have had some issues with Avalere Health's methodology in the past, but they're pretty well respected in the industry, and they've certainly brought up legitimate issues with my own methodology as well (they're the ones who pointed out that the early version of my Medicaid/CHIP estimates was mixing "baseline churn" into the mix, which has since been corrected).

Anyway, they're out with an interesting new study which estimates that there of those newly-added to the Medicaid/CHIP roles, roughly 550,000 of them--specifically in the 24 NON-expansion states--rightly belong in the "woodworker" category: People who already qualified for Medicaid under the pre-ACA rules, but who didn't enroll until after October 1, 2013 for any number of reasons (not knowing they qualified, not knowing how to apply, being embarrassed about doing so, etc). Since the ACA exchanges also included a massive education/outreach effort (some of which even spilled over into the states which didn't expand the Medicaid program), and since the application process was streamlined in many states as part of the law, these folks who "came out of the woodwork" to enroll in Medicaid are rightly considered part of the success of the ACA specifically.

Some more fantastic numbers out of Ohio after the earlier ones from Michigan: 185K strict expansion, 124K woodworkers and another 146K in the works:

Through April though, 184,671 newly eligible applicants were approved for coverage, the state said Monday.

About 563,000 Ohioans became eligible for Medicaid when the state agreed to accept federal support provided under the Patient Protection and Affordable Care Act to pay for broadening the health insurance program. The change raised the household income eligibility limit to include families earning up to 138 percent of the federal poverty rate -- about $32,500 for a family of four. They became eligible for coverage in January.

Another 124,195 people, meanwhile, were also added to Medicaid when it was determined they qualified for the program under the old guidelines. State officials had said they expected the public attention on expanding Medicaid would also draw in people who were already eligible but who had not signed up.

...But about 146,000 applications from that time period are still being processed and could add to the totals.

Michigan may have been 3 months late to the Medicaid expansion game, but once we got started, things really took off. The original target was 320,000 adults in the state...and MI has already reached over 74% of that goal:

My own calculations (based on KFF.org data) give the total number of Michigan residents eligible for Medicaid expansion as about 500,000; even at that number, 237K still represents over 47%, which is fantastic.

My estimate for "woodworkers" in non-expansion Georgia has been around 63,000 people; this article pretty solidly places that number at about 1/3 higher: 91,000 to date:

As of Thursday, DCH has received more than 40,000 “account transfers” from the exchange, “with about 2,000 arriving every hour,’’ an agency spokeswoman, Kallarin Richards, told GHN.

These potential sign-ups in Georgia have been stalled for months due to technological snags.

Community Health said Friday that it’s waiting until all of the transfers have been received from the exchange before processing them. “This will ensure DCH is working from the most recent data and can identify any duplicative applications that may exist,” Richards said in an email.

Federal health officials recently reported that more than 91,000 Georgians were identified through the health insurance exchange as eligible for Medicaid or PeachCare.

BCBSNC reports 232,000 QHPs sold on the ACA exchange...but that's out of about 273,000 total enrollees; they've removed the other 15% who haven't paid their premium yet:

The Blue Cross enrollments reflect insured customers who signed up from October through May 1 and are still paying premiums. About 15 percent of customers who signed up never paid a premium and are not included in the 232,000 figure, Burke said.

So, fine: 85% for Blue Cross of NC. As it happens, NC sold a total of 357,584 policies total, which means BCBSNC sold over 76% of the total.

Now, it's conceivable (but not likely) that 100% of the remaining 84,500 enrollees snapped up by other companies did pay their premiums, but even so, that would only bring the paid percentage up to about 88.5%. So, I think it's safe to say that for North Carolina, 85% is a reasonable "How many have PAID???" figure for the full state until more solid numbers are released.

OK, I know I recently posted my "final" update to The Graph for the first Open Enrollment period...but I included an asterisk next to "final" for two reasons: First, because there will obviously still be more enrollments added throughout the summer and fall (Medicaid, SHOP, etc); second, because I've been debating one other major addition for awhile.

I should reiterate, however, that I was never directly criticizing the study itself...only the completely unfounded conclusions that so many anti-ACA pundits tried to draw from it. The main issue is that the McKinsey study included both on- and off-exchange enrollments (and stated so a good half-dozen times throughout), without any indication of what the ratio between the two was. As a result, that 27% figure could conceivably mean 54% of the on-exchange and 0% of the off-exchange enrollees, or vice-versa, making it completely useless for getting an answer to the question of how many EXCHANGE-BASED QHPs were previously insured.

As regular readers of this site know, I make no bones about my personal politics. I'm very much a progressive Democrat, and my ideology comes out from time to time in my commentary. However, I do my best not to allow that to influence the data or how I present it.

When the enrollment numbers sucked, I agreed that they sucked and recommended that the HHS Dept. be forthcoming with the data anyway. When the Hawaii exchange was still subject to the infamous Heartbleed bug a week or so after it was publicized, I called them on it publicly. When states like Massachusetts subjected a couple hundred thousand of their citizens to a shaky, uncertain "limbo" status due to their exchange being screwed up, I didn't try to cover that over. When a solid case was made that the "3.1 million" young adult figure that the Obama administration has been touting for months may actually be only half of that, I presented the argument, the source, the reasoning and make sure to include the lower figure on The Graph. When the RAND Corp. survey claimed that there have been an additional 8.2 million Employer-Supplied Insurance policies since last fall, I declined to add them to the total due to the bold claim and lack of any collaborating evidence (I still list this figure as a footnote, but am not including it on the Graph).

The numbers are the numbers.

I say all of this because the following is sure to cause quite a bit of controversy...but a) it's related to the ACA, b) it's a serious issue and c) it's horrifying.

Nevada is the only exchange still officially open for "normal" private QHP enrollments (although of course SHOP, Medicaid, etc. are all year-round). WIth this update, Nevada's paid QHP rate jumps from 71% up to 76% (still not great, but an impressive spike in one week...more the existing enrollees catching up with their payments than new ones being added):

The board overseeing Nevada Health Link was told Thursday that nearly 35,000 people had enrolled in a qualified health plan as of May 3, halfway through a two-month special enrollment period that ends May 30.

Another 11,000 have selected plans but not yet paid for them.

Managers believe they had QHP enrollment information and premium payments for 34,820 residents as of May 3.

In spite of their several-hundred-million-dollar meltdown of a website, Oregon has managed to pull off an impressive feat: Between private QHPs, standard Medicaid/CHIP and their "fast track" program (not included below), they've enrolled nearly 400,000 people in healthcare plans of one sort or another via the ACA.

So, the absurd GOP House Energy & Commerce Committee Report which claimed that only 67% of exchange QHP enrollees are paid up has been thoroughly demolished by not just myself, but pretty much every other legitimate news media outlet there is (which leaves out FOX News, I'm afraid). In addition to only running through 4/15 (when 38% of the total QHP payments weren't even due yet), it only counted 160 of the 300+ insurance providers on the ACA exchanges, among many other ludicrous methodological flaws.

However, something did just occur to me. Take another look at their state-by-state breakout (which, again, only includes states on the Federal exchange...and even then, leaves out Idaho and New Mexico for reasons unknown), and there's several states which I find rather interesting:

OK, this doesn't give a complete picture of Alabama's exchange QHP payment rate for two reasons: First, because the 82% figure is a blend of 85K via the exchange and another 20K off-exchange enrollees; second, because while BCBS does have the lion's share (87%) of exchange QHP enrollees in the state, there's still another 12,870 QHPs (out of the 97,870 total in Alabama) which belong to other insurance companies, which may have a higher or lower payment rate to date.

Having said that, assuming that the ratios are representative on both counts, it looks like about 82% of Alabama's enrollees have paid so far:

Some 82 percent of those enrolling in Blue Cross and Blue Shield of Alabama through the exchanges have paid their first month's premium, mirroring figures released today by other large insurers in preparation for congressional testimony.

"We have enrolled over 105,000 members both on and off the federally facilitated exchange in Alabama," said Koko Mackin, BCBS of Alabama said in an email to Al.com. "Over 85,000 members enrolled through the federal exchange, while another 20,000 signed up directly with Blue Cross -- 82% of our exchange enrollees have paid their first month’s premium."

Today, the Department of Health and Human Services announced that new preliminary data show an overall nine percent decrease in hospital acquired conditions nationally during 2011 and 2012. National reductions in adverse drug events, falls, infections, and other forms of hospital-induced harm are estimated to have prevented nearly 15,000 deaths in hospitals, avoided 560,000 patient injuries, and approximately $4 billion in health spending over the same period.

OK, not exactly the most stunning headline in the world (although this does appear to be shocking news to a certain anti-ACA political party), but still kind of cool to have some solid numbers on just how many lives could be saved with universal coverage:

Results: Reform in Massachusetts was associated with a significant decrease in all-cause mortality compared with the control group (−2.9%; P = 0.003, or an absolute decrease of 8.2 deaths per 100 000 adults). Deaths from causes amenable to health care also significantly decreased (−4.5%; P < 0.001). Changes were larger in counties with lower household incomes and higher prereform uninsured rates. Secondary analyses showed significant gains in coverage, access to care, and self-reported health. The number needed to treat was approximately 830 adults gaining health insurance to prevent 1 death per year.

Limitations: Nonrandomized design subject to unmeasured confounders. Massachusetts results may not generalize to other states.

Conclusion: Health reform in Massachusetts was associated with significant reductions in all-cause mortality and deaths from causes amenable to health care.

Not exactly surprising, but rather embarrassing for the state which spawned the ACA in the first place.

If the "off-the-shelf" replacement works, great. If not, and they follow Oregon into having HC.gov take over, that would mean a net change of...zero states, with MA and OR moving into the fold while New Mexico and Idaho break out on their own exchanges.

Massachusetts has scrapped its hopes for a totally customized state-based health exchange under the Affordable Care Act, and will instead purchase an “off-the-shelf” solution that can be installed by the fall with the possibility of joining the federal exchange if all else fails.

The state announced Monday that it would contract with Virginia-based hCentive for health insurance exchange software that has been used to power online marketplaces Kentucky, Colorado, New York and other states.

Health and IT officials will simultaneously work to ready the state and its insurers to join the federal health exchange in case the hCentive software solution cannot be implemented in time for the next insurance open enrollment period that begins in November.

If I'm going to boast about the states where high percentages of QHPs are paid for (WA, MA, CT, OR, WV & RI, for starters), I do have to be honest and present the lower figures as well. According to the SC insurance commissioner, only about 71.3% of exchange QHPs in that state had been paid up as of 4/30, which is admittedly not great:

Of the 119,784 individuals in South Carolina who applied and selected a policy on the federal exchange, 85,453 - about 71 percent - paid their first month's premium by April 30, Farmer said. That was the last possible day to make that first payment. Those who didn't pay by that date aren't actually insured, he said.

As a side note, that 119,784 figure is actually higher than the official 4/19 HHS total of 118,324; presumably another 1,460 trickled in from 4/20 - 4/30. Even using the lower number, however, the paid rate would only be 1% higher (72.2%).

As many as 90 percent of WellPoint customers have paid their first premium by its due date, according to testimony the company prepared for a congressional hearing today. For Aetna, the payment is in the “low to mid-80 percent range,” the company said in its own testimony. Health Care Service Corp., which operates Blue Cross Blue Shield plans in five states including Texas, said that number is at least 83 percent.

Oh, yeah...and regarding that absurd "67%" Republican House committee report from last week, I'm not the only one who knew it was a big pile of crap:

“That was just foolishness on the part of the committee to even publish that number because it was completely out of context,” Bob Laszewski, an insurance industry consultant in Alexandria, Virginia, said in a phone interview.

Not much for me to add to this, really, other than to say that THIS is the correct answer to the "But...but how many were ALREADY INSURED???" complaints:

Uninsured rate down nearly four percentage points since late 2013

WASHINGTON, D.C. -- The uninsured rate for U.S. adults in April was 13.4%, down from 15.0% in March. This is the lowest monthly uninsured rate recorded since Gallup and Healthways began tracking it in January 2008, besting the previous low of 13.9% in September of that year.

The uninsured rate peaked at 18.0% in the third quarter of 2013, but has consistently declined since then. This downward trend in the uninsured rate coincided with the health insurance marketplace exchanges opening in October 2013, and accelerated as the March 31 deadline to purchase health insurance coverage approached -- and passed -- for most uninsured Americans. The Obama administration decided in late March to extend the deadline to April 15 for those who had already begun the enrollment process.

A couple of days ago, Avalere Health (with whom I've alternately butted heads and agreed with on various Medicaid enrollment data issues) released a study which, at first glance, seems to paint a fairly positive picture of how well the ACA exchange QHP enrollment ended up doing: Enrollment expectations were exceeded in 22 states, even if you assume only an 85% final premium payment rate!

However, there's a couple of data points which Avalere chose to use which made me furrow my brow. The first is that they based their findings on the CBO's lowered projection number of 6 million exchange-based QHPs instead of the original 7 million figure. I suppose there's nothing wrong with doing this, but considering that the actual grand total ended up being well over 8 million, it seemed a bit odd to me that they'd choose to compare the state-level figures against the lower, 6 million figure when there really isn't a need to do so.

In addition to the March/April HHS report being released on Thursday, the CMS Dept. decided to take care of everything in one shot and also released the March (only...no April data included) CMS report as well.

As a result, I just finished plugging in the data from both reports onto the Medicaid/CHIP spreadsheet (followed, of course, by having to go through and delete out big chunks of the data from one or the other to avoid double-counting or any Medicaid renewals).

Normally each of these reports (which are usually released a couple of weeks apart) bumps the new Medicaid/CHIP numbers up by a half-million or so apiece after separating out the renewals & baseline churn. This time around, the impact looks much more dramatic because 1) both reports were added on the same day, 2) the HHS report includes 2/3 of April as well as March and 3) there appears to have been a bit of a spike in Medicaid enrollments as the 3/31 open enrollment deadline approached just as there was for QHPs (this may sound strange since there's no deadline for Medicaid, but a lot of people might not have realized that, and the frenzied outreach effort probably swept up a lot of potential Medicaid enrollees in the final weeks of March as well).

Online private insurance broker eHealth Insurance has provided a detailed Price Index Report covering the full open enrollment period from October 1, 2013 - March 31, 2014. For the most part it focuses on the pricing demographics, but also gives an updated number of policies as well (all of which are fully ACA-compliant QHPs purchased off-exchange):

Data collected and presented is based on over 213,000 individual and family health insurance applications submitted through eHealthInsurance.com between October 1, 2013 and March 31, 2014.

The prior number I had from back in January was around 148,000, so this is a significant increase...but it also specifies "individual and family" applications, so I'm assuming the standard 1.8x-per-household factor, which brings the total number of lives covered up to around 383,000 people.

However, until/unless I'm able to separate out any Blue Cross (or other BCBSA) enrollments from the total, I can't really plug this number into the spreadsheet, so I'll leave it as a blog entry for now.

One of the more interesting parts of the March/April HHS report is that they finally released the data for the "Are you currently insured?" question on the HC.gov enrollment process.

Given all the fuss about "But how many were ALREADY INSURED???" from various outlets, this would seem to be a bit of a Holy Grail answer: At last, we know the answer, and it's pretty impressive: Only 13% responded that they had health insurance coverage at the time of their application, meaning a whopping 87% were newly insured! Wowzers!!

Christine Ferguson, executive director of HealthSource RI, said 91% of the 27,968 individuals who signed up for private plans during the open enrollment period from Oct. 1 to March 31 paid their first premiums by the April 23 deadline. Analysts have pointed to that percentage as a key test of whether the enrollment figures were as strong as they looked.

“My takeaway of that 91% is that we have work to do to keep them, but that’s a high conversion rate, and it’s a testament to the work that the staff’s done to really work with people,” Ferguson told WPRI.com.

“I think it’s a reflection of the work that’s been done in the marketplace, the care that we took in the kinds of plans we offered and the range, and I think it is a reflection of the system working reasonably well,” she said. “I think for us the real issue – and I think the thing that people have not paid enough attention to nationally – is retention.”

I actually already posted an entry using this exact same story out of the WV Gazette, but thanks to Esther Ferington for pointing out something else that I missed in the article:

Health insurance enrollment numbers through the federal exchange surged to 18,631 between March 31 and the April 15 federal extension, Highmark West Virginia President Fred Earley said.

Highmark, the only insurer participating in West Virginia's Affordable Care Act insurance marketplace, also reported that 6,171 people have enrolled directly through Highmark since Oct. 1.

The numbers released represent the highest jump in enrollment the company has seen since the ACA rollout; it reported in April that, as of March 31, 14,839 people had enrolled through the exchange and 5,292 purchased plans directly through Highmark.

I'm assuming this is due to correction of some clerical errors, double entries, unpaid or cancelled acounts and so on, but the 4/26 county-by-county tally from Connect for Health Colorado is actually about 1,500 lower than the 4/19 total from the HHS report:

Given that they were only at 8,742 just a few days earlier, Hawaii managed to pull off an impressive (relatively-speaking) mini-surge in the final few days:

The Hawaii Health Connector, the online marketplace responsible for implementing President Barack Obama’s Affordable Care Act in Hawaii, enrolled 9,800 residents as of Wednesday’s final deadline for its first year of providing coverage.

The Connector collected 31,310 individual applications as of Saturday but was unable to enroll two-thirds of those applicants despite a push in the final two months.

An even greater number in Ohio, 156,899, were deemed eligible for Medicaid or the Children's Health Insurance Plan, or CHIP, government plans for low-income families that have been expanded under the act. That, however, is only a partial number, based on information that individuals provided when they contacted the federal health care marketplace to see about insurance. According to state figures released by the U.S. Department of Health and Human Services, Ohio has seen a combined Medicaid-CHIP surge of 208,280 since the Affordable Care Act, or ACA.

This is really more of a confirmation of my own estimates than anything; I had Iowa down as around 81K "Strict Expansion" plus another 800 or so "Woodworkers". The actual total appears to be slightly less: 78,860. Not sure what the breakout between the two is, I'm going to assume roughly 75K "strict" and another 3,860 "woodworkers" for now:

The federal report also said that 78,860 Iowans more were enrolled in Medicaid or related programs at the end of March than were enrolled in those programs last fall. Medicaid is a joint federal and state health-care program for the poor. Under the Affordable Care Act, states could opt to expand their Medicaid programs' rules to allow more poor, working-age adults to join. Iowa chose to do so with a pair of programs, the Health and Wellness Plan and the Marketplace Choice Plan, which have similarities to Medicaid. There is no deadline for Medicaid enrollment. People who qualify for the public plans can sign up any time.

Remember, the HHS report from yesterday only runs through 4/19...there's still 11 days worth of data missing from most states...

DOVER, Del. (AP) — Final enrollment numbers released by state officials Thursday show that 14,397 Delawareans signed up for health insurance coverage under the federal Affordable Care Act in the first year of open enrollment.

....Health and Social Services Secretary Rita Landgraf told the state Health Care Commission that 4,217 other Delawareans were found eligible for coverage under expanded Medicaid rules the state adopted as part of an effort to reduce the number of uninsured residents.

There's some off-exchange numbers here as well (6,171), but that's from Highmark, so I can't double-count it (part of BCBSA).

However, the Medicaid/CHIP numbers continue to astonish in WV:

The DHHS also reported that 136,418 West Virginians enrolled in Medicaid and CHIP through the end of March. According to Jeremiah Samples, deputy secretary for the state’s Department of Health and Human Resources, West Virginia has enrolled 117,522 people in expanded Medicaid — more than twice the 63,000 that actuarial studies had predicted for the first year of enrollment.

According to the Kaiser Family Foundation, the total number of people eligible for ACA Medicaid expansion in WV is around 143,000...meaning that they've managed to achieve an amazing 82% of this goal in the just 7 months.

A reader sent in an interesting report on the DoD's TRICARE program, which apparently was already an existing military version of the ACA "young adults on parents plans" provision. Prior to the ACA, TRICARE only covered young adults up to 21 or 23; the ACA expanded this to the same 26 year old cut-off as non-military families:

Page 52 - As shown in the chart at left, enrollment went from over 21,000 in FY 2012 to almost 31,000 in FY 2013.

Also, although TYA began with the Standard option, Prime now accounts for almost 60 percent of total TYA enrollment.

This is in reference to the Tricare Young Adult program coverage for those under 26. This is a small amount but doesn't seem to fit anywhere except the under 26 coverage.

Tricare used to cover dependents under 21 with extension to 23 for those in school. The ACA enable expansion to under 26 for a fee ($180/month)

I'm not adding this to the actual spreadsheet since a) it's such a tiny number and b) it's hard to say how many of the 10K increase is specifically due to the ACA, but I thought it was worth at least mentioning.

As I noted yesterday, there are three states which had unusually large discrepancies between the official HHS and state exchange QHP enrollments:

New York came in over 65,000 lower than the number I had for a simple reason: The New York exchange lumps enrollees in their Child Health Plus program in with QHPs, even though technically this isn't a QHP program. There were over 40,000 of these as of the end of February; this number has climbed to 65,028 as of 4/19.
Since Child Health Plus is privately funded (and therefore isn't on the Medicaid/CHIP side), but also isn't officially a QHP either according to HHS, I've moved it over to the "Off Exchange QHP" column.

Hmmm...this article about Michigan's final ACA exchange tally is very specific about the Healthy Michigan program (Michigan's ACA expansion program), claiming the total is nearly 200K total...but if so, this would be an increase of over 41,000 from just 3 days earlier, which I find hard to believe (though that'd be awesome if it's correct).

199,862 minus the 36,307 who were bulk-transferred over from the existing state program = 163,555. The update from just 3 days ago had the total as 158,654.

HOWEVER, it occurs to me that I may have actually assumed that the 158K figure included the 36K transferees...if it didn't, then this makes much more sense, since the difference over those 3 days is only 4,901 people.

If that's the case, then this is VERY impressive indeed, and I apologize for lowballing the earlier number! I'll go ahead and use the higher number for now; on Monday there will a new official update on the state government site, and I can verify things one way or the other:

Don't forget, there's still a few states with exchange QHPs trickling in...in the case of Oregon, they can tack on an extra 1,300 to their QHP tally & another 4,700 Medicaid enrollees...in addition to the 128,434 "fast track" Medicaid enrollees they added earlier this year. Their new grand totals now stand at nearly 70K exchange QHPs and over 305K Medicaid additions:

Well, I had it down as 8.03M as of 4/15; the actual was 8.02M as of 4/19. So...hard to say precisely how accurate I was since the dates don't match, but obviously I slightly overshot the mark. On the other hand, I also called 8.14M as of 4/30, so presumably there will be a follow-up report in another week or so with the "mop-up" enrollments from the final 11 days.

TEXAS: Was 295K as of 3/01; 734K as of 4/19

FLORIDA: Was 442K as of 3/01; 984K as of 4/19

GEORGIA: Was 139K as of 3/01; 317K as of 4/19

I'll start plugging the actual numbers into the spreadsheet next.

UPDATE: OK, I've plugged all of the official HHS numbers into the spreadsheet. There are a handful of states where the numbers don't quite match, presumably due to clerical cleanup, double-entries being removed, etc. However, there are six states with significant differences, two of which I can't figure out:

OK, I was suckered about this a couple of weeks ago, but I'm pretty damned certain about it this time: The HHS Dept. should be releasing their official ACA exchange report for all of March (and almost certainly the first half of April) in about 2 hours (around 2:15pm).

Their 67% figure assumed that all enrollees as of 4/15 were supposed to be due by 4/15 (in fact, only about 63% of the total enrollments were due by 4/15; the rest weren't due until yesterday, or even later depending on the insurance company)

Their "only 67%" claim flies in the face of public statements by the insurance companies themselves, who are quite clear that the actual paid percentages range anywhere from 80-95%

They curiously failed to include two states--Idaho and New Mexico--in their own state-by-state breakdown, even though both of those states were part of the Federal Marketplace for the 2014 open enrollment period (both are scheduled to switch to their own exchanges this fall, but that's irrelevant to the existing enrollments)

Even if the 67% figure was accurate for the 36 states on the federal exchange, the paid rates for the other 14 state-run exchanges (+DC) ranged from 68% - 100% as of 4/15, including WA & MA at 100%, CA at 85% (making up nearly 20% of the 8M total) and so on, meaning that the actual overall paid rate nationally as of 4/15 was considerably higher than 67%.